How To Use CPT Code 5200F

CPT 5200F describes the consideration of referral for a neurological evaluation of appropriateness for surgical therapy for intractable epilepsy within the past 3 years. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 5200F?

CPT 5200F can be used to document that a provider has considered referring a patient to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy within the past 3 years. This code is used when the provider evaluates the appropriateness of surgical therapy as a treatment option for the patient’s epilepsy.

2. Official Description

The official description of CPT code 5200F is: ‘Consideration of referral for a neurological evaluation of appropriateness for surgical therapy for intractable epilepsy within the past 3 years (EPI)’. This code indicates that the provider has considered referring the patient to a neurosurgeon to evaluate whether surgical therapy is a suitable option for treating their intractable epilepsy.

3. Procedure

1. The provider assesses the patient’s epilepsy and determines if it is intractable, meaning it is not responsive to pharmacologic therapy.
2. If the patient’s epilepsy is deemed intractable, the provider considers surgical therapy as a potential treatment option.
3. The provider may consult with a neurosurgical specialist to evaluate the appropriateness of surgical therapy for the patient’s epilepsy.
4. Documentation should include the date of the consideration, the patient’s diagnosis of intractable epilepsy, and any discussions or consultations with a neurosurgical specialist.

4. Qualifying circumstances

CPT 5200F is applicable when a provider considers referring a patient to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy within the past 3 years. This code is used when the patient’s epilepsy is not responsive to pharmacologic therapy and surgical therapy is being considered as a potential treatment option. The provider must document that the referral for evaluation was considered within the specified timeframe.

5. When to use CPT code 5200F

CPT code 5200F should be used when a provider considers referring a patient to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy within the past 3 years. It is important to note that this code should not be used if the referral for evaluation was not considered within the specified timeframe.

6. Documentation requirements

To support the use of CPT code 5200F, the provider must document the following information:

• Date of the consideration for referral
• Patient’s diagnosis of intractable epilepsy
• Discussion or consultation with a neurosurgical specialist regarding the appropriateness of surgical therapy

7. Billing guidelines

When billing for CPT code 5200F, ensure that the provider has considered referring the patient to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy within the past 3 years. This code should not be reported with other codes unless they are directly related to the consideration of referral. It is important to follow the specific guidelines provided by the payer when reporting this code.

8. Historical information

CPT code 5200F was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Examples

1. A provider considers referring a patient with intractable epilepsy to a neurosurgical specialist for evaluation of surgical therapy.
2. After determining that pharmacologic therapy is not effectively controlling a patient’s epilepsy, the provider considers surgical therapy and documents the consideration within the past 3 years.
3. A patient with intractable epilepsy is evaluated by a provider who considers referring them to a neurosurgical specialist for evaluation of surgical therapy.
4. During a follow-up visit, the provider discusses the potential of surgical therapy for a patient’s intractable epilepsy and documents the consideration within the past 3 years.
5. After reviewing the patient’s medical history and previous treatment options, the provider considers referring them to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy.
6. A provider evaluates a patient’s intractable epilepsy and considers the appropriateness of surgical therapy, documenting the consideration within the past 3 years.
7. During a consultation with a neurosurgical specialist, the provider discusses the potential of surgical therapy for a patient’s intractable epilepsy and documents the consideration within the past 3 years.
8. After a thorough evaluation of a patient’s epilepsy, the provider considers referring them to a neurosurgical specialist for evaluation of surgical therapy and documents the consideration within the past 3 years.
9. A provider reviews the patient’s medical records and considers referring them to a neurosurgical specialist for evaluation of surgical therapy for intractable epilepsy, documenting the consideration within the past 3 years.
10. During a discussion with the patient, the provider considers the potential benefits of surgical therapy for their intractable epilepsy and documents the consideration within the past 3 years.